Elsevier

Gastrointestinal Endoscopy

Volume 85, Issue 6, June 2017, Pages 1157-1168.e2
Gastrointestinal Endoscopy

Systematic review and meta-analysis
Retention associated with video capsule endoscopy: systematic review and meta-analysis

https://doi.org/10.1016/j.gie.2016.12.024Get rights and content

Background and Aims

Video capsule endoscopy (VCE) has become a major diagnostic tool for small-bowel evaluation. However, retention of the video capsule endoscope remains a major concern.

Methods

We performed a systematic review of VCE retention rates by using Pubmed and SCOPUS (1995-2015). We included studies that enrolled at least 10 patients, included VCE retention rates, and separated retention rates by indication. We used Comprehensive Meta-Analysis (Version 3.0) to calculate pooled prevalence rates with 95% confidence intervals (CIs) and assessed heterogeneity by using the Cochran Q statistic.

Results

We included 25 studies (N = 5876) for patients undergoing VCE for evaluation of potential small-bowel bleeding, 9 studies (N = 968) for patients with suspected inflammatory bowel disease (IBD), 11 studies (N = 558) for patients with established IBD, and 8 studies for patients (N = 111) undergoing VCE for evaluation of abdominal pain and/or diarrhea. We used a random effects model and found that the pooled retention rate was 2.1% for patients with suspected small-bowel bleeding (95% CI, 1.5%-2.8%). Retention rates were 3.6% (95% CI, 1.7%-8.6%) for suspected IBD, 8.2% (95% CI, 6.0%-11.0%) for established IBD, and 2.2% (95% CI, 0.9%-5.0%) for abdominal pain and/or diarrhea. Based on subgroup analysis, subsequent VCE completion rates after performance of a patency capsule or CT enterography in patients with IBD to exclude retentions due to strictures was 2.7% (95% CI, 1.1%-6.4%). Reasons for retention were provided in 60 (77%) studies. The most common reasons for retention were small-bowel strictures, although etiology was not provided in all studies.

Conclusion

VCE retention occurs in approximately 2% of patients undergoing evaluation for small-bowel bleeding and is most likely due to small-bowel strictures. Retention rates in patients with suspected or known IBD were approximately 4% and 8%, based on our meta-analysis. These rates decreased by half in those studies that used either a patency capsule or CT enterography to assess patency before performing VCE.

Section snippets

Background

Video capsule endoscopy (VCE) has become a major diagnostic tool for the evaluation of small bowel disorders since its introduction to the scientific community via Nature in 2000.1 This is in part due to the fact that other techniques for evaluation of the small bowel, including radiography, scintigraphy, operative enteroscopy, push enteroscopy, and double-balloon enteroscopy, are either insensitive, time-consuming, invasive and/or not widespread.2

Advantages associated with usage of VCE have

Literature search

By using key search terms of capsule endoscopy and retention (Appendix 1, available online at www.giejournal.org), we performed a comprehensive literature search from 1995 to 2015 by using Pubmed (N = 243) and SCOPUS (N = 314). We included cohort studies (both retrospective and prospective) that enrolled at least 10 patients undergoing video capsule endoscopy (VCE) for any indication including suspected small-bowel bleeding, suspected or known inflammatory bowel disease (IBD), suspected

Results

The search resulted in 557 references initially, 269 of which were related to VCE. We excluded 202 publications that were not related to the topic of VCE retention, included pediatric patients, were not published in English, or were case reports and/or review articles. Of the 67 remaining articles, 10 were excluded for using patency capsules and 6 for not separating capsule retention rate by indication. In addition, 6 more articles were excluded that were abstracts for which the full

Discussion

VCE has become a common diagnostic tool used for the evaluation of small-bowel disorders, especially small-bowel bleeding and suspected or established Crohn’s disease. However, capsule retention is a rare but potentially serious adverse event. Rates of retention for various indications for the capsule endoscopy vary in the literature, with GI bleeding rates commonly cited around 2% and Crohn’s disease as high as 13%.46

In our analysis, the rates of capsule retention associated with occult and/or

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    DISCLOSURE: L. Gerson is a consultant for Capsovision, Inc and Olympus. All other authors disclosed no financial relationships relevant to this publication.

    See CME section; p. 1284.

    If you would like to chat with an author of this article, you may contact Dr Gerson at [email protected].

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